Provider Demographics
NPI:1306215207
Name:MADRID, LILIE
Entity Type:Individual
Prefix:
First Name:LILIE
Middle Name:
Last Name:MADRID
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10828 DALEROSE AVE
Mailing Address - Street 2:
Mailing Address - City:LENNOX
Mailing Address - State:CA
Mailing Address - Zip Code:90304-2230
Mailing Address - Country:US
Mailing Address - Phone:424-227-1336
Mailing Address - Fax:
Practice Address - Street 1:21810 NORMANDIE AVE
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502-2047
Practice Address - Country:US
Practice Address - Phone:424-201-3226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-09-21
Last Update Date:2023-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
No172V00000XOther Service ProvidersCommunity Health Worker